Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Department of Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
BMC Med Inform Decis Mak. 2022 Nov 19;22(1):302. doi: 10.1186/s12911-022-02040-z.
Telemedicine is increasingly relied upon for care delivery in primary care, but the impact of visit type on clinical ordering behavior is uncertain.
Within Kaiser Permanente Northern California, we identified patients who self-scheduled and completed telemedicine encounters with their personal primary care provider or another available primary care provider in the same medical group, between April 1st, 2020, and October 31st, 2020, while physical distancing restrictions for COVID-19 were in place. We collected patient sociodemographic and clinical characteristics, measures of technology access, and categorized the most common primary encounter diagnoses. We measured proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups (Skin & Soft Tissue, Musculoskeletal Pain, Back Pain, General Gastrointestinal, Hypertension & Diabetes, Mental Health, Upper Respiratory, and Abdominal Pain), and compared physician orders for medications, antibiotics, lab and imaging studies by visit type within each diagnosis group.
There were 273,301 included encounters, with 86,676 (41.5%) video visits and 122,051 (58.5%) telephone visits. Of the diagnosis groups, Skin & Soft Tissue conditions had the highest proportion of video visits (59.7%), while Mental Health conditions had the highest proportion of telephone visits (71.1%). After adjusting for covariates, the overall rates of medication orders (46.6% vs. 44.5%), imaging orders (17.3% vs. 14.9%), lab orders (19.5% vs. 17.2%), and antibiotic orders (7.5% vs. 5.2%) were higher during video visits as compared to telephone visits (p < 0.05). The largest difference within diagnosis groups was for Skin & Soft Tissue conditions, where the rate of medication orders was 9.1% higher than during video visits than telephone visits (45.5% vs. 36.5%, p < 0.05).
We observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Our findings suggest that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.
远程医疗越来越多地用于初级保健的医疗服务，但就诊类型对临床医嘱行为的影响尚不确定。
在 Kaiser Permanente Northern California，我们在 2020 年 4 月 1 日至 2020 年 10 月 31 日期间，当 COVID-19 物理隔离限制生效时，识别了自行预约并通过个人初级保健提供者或同一医疗集团内其他可用初级保健提供者完成远程医疗就诊的患者。我们收集了患者的社会人口统计学和临床特征、技术访问措施，并对最常见的初级就诊诊断进行了分类。我们测量了每个诊断组中 8 个诊断组（皮肤和软组织、肌肉骨骼疼痛、背痛、一般胃肠道、高血压和糖尿病、心理健康、上呼吸道和腹痛）中患者预约视频和电话就诊的比例，并比较了每个诊断组内不同就诊类型的医生开具的药物、抗生素、实验室和影像学研究的医嘱。
共纳入 273301 例就诊，其中 86676 例（41.5%）为视频就诊，122051 例（58.5%）为电话就诊。在诊断组中，皮肤和软组织疾病的视频就诊比例最高（59.7%），而心理健康疾病的电话就诊比例最高（71.1%）。调整协变量后，药物医嘱的总体比例（46.6%比 44.5%）、影像学医嘱的总体比例（17.3%比 14.9%）、实验室医嘱的总体比例（19.5%比 17.2%）和抗生素医嘱的总体比例（7.5%比 5.2%）在视频就诊中均高于电话就诊（p<0.05）。在诊断组内，差异最大的是皮肤和软组织疾病，药物医嘱的比例比电话就诊高 9.1%（45.5%比 36.5%，p<0.05）。
我们观察到在常见初级保健条件下远程医疗就诊中，就诊类型对临床医嘱有统计学意义上的差异。我们的研究结果表明，对于某些疾病，视频就诊中传递的视觉信息可能会促进临床检查和治疗。
